Provider Demographics
NPI:1851728166
Name:WILKIE, STEPHANIE LYNN (LPCA)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:LYNN
Last Name:WILKIE
Suffix:
Gender:F
Credentials:LPCA
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:L
Other - Last Name:WILKIE-PIROLO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPCA
Mailing Address - Street 1:105 S CEDAR ST STE D
Mailing Address - Street 2:
Mailing Address - City:SUMMERVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29483-6078
Mailing Address - Country:US
Mailing Address - Phone:757-575-4280
Mailing Address - Fax:757-575-4280
Practice Address - Street 1:105 S CEDAR ST STE D
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29483-6078
Practice Address - Country:US
Practice Address - Phone:757-575-4280
Practice Address - Fax:757-575-4280
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
225C00000X
SC8143101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor